"I felt I must write and thank you for the care and consideration shown to me over the last six months, when I have been undergoing various tests in your department. Times like this are always worrying and stressful, but your friendly welcoming attitude and professional and jargon-free communication of results and advice helped make it easier to cope with.Although I have decided not to have any further treatment at the moment, I would again like to thank you all and say your department has a wonderful team." - Mrs. Bonareri Margaret

"I have been attending the hospital (3 times monthly) via the "Hospital Ambulance Service" so I have had plenty of time sitting in the waiting area and observing people come and go. I feel that this is one of the most pleasant clinics for patients to come to in the RVI. I have experienced a consisitently friendly and cheerful welcome from the receptionist Ann, approachable and encouraging attitudes from the nursing staff, and a positive, caring atmosphere throughout the whole area. Whereas I used to dread hospital visits in general, I don't find it so difficult now mainly due to the "better" experience I have had, and the fact that I have confidence that I will be well-treated in this clinic. Ahsante Sana!"

"I visited the Kisii Teaching & Referral Hospital(in November 2014) and I must comment on the quality of service I received and the friendly helpful attitude of all the staff that I came into contact with. I was very impressed by the organisation, the hygiene, the treatment and the communication." - John Williams (USA)

Back pain is caused from a variety of problems including “Acute Pulmonary Edema.” Edema builds up abnormal and excessive fluids that cause serious actions to the tissue cells. What happens is similar to over watering plants. The plant will swell and gradually wither away.

Edema in acute stages is defined as heart failure to one side, yet the problem extends to cause pain in the back. What occurs is when the heart is interrupted; it channels the fluids to tubes, vessels, ducts, and passageways that extend to the lungs.

The lack of heart pumping can cause stress to the chest, which when the chest is scarred it affects the spines structure and mobility. Overarching the back is where back pain starts, since the chest is restricted from scarring and/or edema.

Experts will often use X-rays, ABG tests, ECG, and monitor Homodynamic to discover edema. Of course, edema can lead to major problems, such as Hypernatremia, Digoxin Toxicity, Hypokalemia, Excessive Fluid, and Pulmonary Blockage of the arteries, (Embolism), which starts blood clotting and affects blood circulation. Hypokalemia will decrease potassium intake that is required by blood. What happens is the decrease of potassium to the blood causes excessive excretion of fluids that lead to the muscles, which cause weakness. The back pain is not necessary the issue at this stage, since the heart is the starting point, which could lead to cardiac arrest.

When acute edema is present, experts will often restrict fluid intake, while administering I.V. fluids to substitute. Oxygen and meds are prescribed. Often the doctor will request that the patient remain consistent in a high position, such as “Fowler’s.”

Experts will request that the patient limit fluid intake, and join in oxygen therapy. Since edema causes excessive fluid buildup, isometric exercises, and bed, rest is required. Isometric workouts is the process of pushing muscles next to a sturdy surface, whereas the muscles are put under tension, yet restricted from contractions. The exercises are recommended in a variety of medical treatments when back pain is involved.

Edema also affects the joints, cartilages, muscles etc, which can cause tenderness, ulcers of the legs, changes of stasis, and so forth. Edema affects the veins found in the neck as well, which is one of the leading starts of back pain. To avoid traveling into the heart cavity and discussing heart conditions, I will sum up edema and the causes of back pain.

As I mentioned earlier, back pain starts with edema since when the heart is not pumping blood it affects the connective tissues, ligaments, tendons, muscles, cells, joints, etc. As you can see, when the skeleton elements are targeted pain will occur from swelling and inflammation. The cause of back pain then starts with excessive fluid buildup emerging from acute edema and/or peripheral edema conditions.

To learn more about edema and back pain consider tendons, ligaments, disks, joints, connective tissues, neurological disorders, and so on.

Back pain has affected millions of people, yet the leading causes emerge from nerve and musculoskeletal disorders. Still, many diseases and disorders can cause back pain, including edema. In fact, when doctors discover musculoskeletal and nerve disorders, they often link one of the potential causes to edema.

What we should do?------------------1, Always keep the baby neat and clean.

2, Cut the nails properly with utmost care.

3, Wet nappy should be removed and parts should be cleaned with soap.

4, Take care of the genitals because fungal infection is common in that area. Parts should be kept dry.

5,Care of the scalp is very important.Fungal infections, dermatitis ect can be prevented by proper cleaning.

6,Tight dress can cause irritation, hence dress should be loose and should allow entry of air.

7,Room should have sufficient light and ventilation.It should be free from dust and insects.

8,Seperate bed preferably water proof is needed for kids .It should be arranged near mother's bed.

9, Always keep some music making toys near the baby.

10, While carrying the baby support the head with hand.Since the neck muscles are weak sudden fall of head can be dangerous.

11, Mothers milk is the best nutrition for the baby,it also gives emotional attachment.Breast milk should be given as per the babies need preferably in mother sitting position.Proper cleaning of nipple is also necessary.Mother should take good nutritious diet throughout lactating period.

12, If there is some contraindication for breast feeding cows milk can be given.Feeding bottle should be cleaned with warm water and should be kept dry till next use.

14, Some children are allergic to some substances like food,milk,dress,cosmetics ect.. Try to find out the material causing allergy and avoid such things.

15, Mosquito nets should be used regularly.Diseases like malaria,dengue ,filariasis,yellow fever and ect spread through mosquito bites. Mosquito bite can also produce skin eruptions with some allergic reactions.It also disturbes sound sleep.

16, A calm atmosphere should be maintained for a good sleep.Compared to adults infants need more sleep.It is said that growth hormone secretion is activated during sleep.

17, Growth developement,behavioral developement,motor developement,personal social developement,language developement ect should be noted down in relation to age. However parents need not be over anxious because slight variations are seen from individual to individual.

18,Assessment of growth by measuring height and weight is necessary.

19, In the early months of life infant may defecate after every feed.Proper toilet training should be given when the infant grows.The infant can be placed on the toilet seat by the age of ten months.

20, The toilet seat (potty seat) should be cleaned with antiseptic liquid before and after use.It should not be shared by other children.

21, If the baby shows some signs of distress like excessive crying,convulsions,fever with rigor,stiffness of neck,frequent vomiting and diarrhoea,bluish discolouration of the body,difficult breathing with grunting, ect pay attention and consult your doctor.

22,A first aid box should be kept in the room ,which should contain sterile cotton,dressing materials,antiseptic lotion and ointment and forceps.Seperate book should be maintained to note down the phone numbers of doctors, ambulance,police ect.

23,Child's medicines should be kept in seperate box.Information regarding dose and mode of administration should be written in a paper and affixed on the box.

24, while driving keep the baby in seperate seat belt.

25, When you are going out with the baby keep an identity card with your phone number and address inside his small pocket.

26, When the infant starts walking always accompany him to prevent a fall and injuries thereby.

27, In emergencies take the first aid measures and take the victim to nearby hospital.

Choking :--The baby may swallow some solid objects and cause obstruction. Immediately make the baby to lie on the abdomen in head low position and press the abdomen backwards and towards the chest. Stroking the upper back is also useful. If no result call a trained person to take the material with the help of forceps.

Accidental poisoning:-- Try to takeout the poisonous subatance and induce vomiting (except kerosine & acids). Wash the body with water to reduce absorption through skin.Identify the pioson and take the victim to the hospital.

Burns:--First of all remove the source of heat and put clean cold water.Burned cloaths should not be removed immediately. Cover the wound with sterile cotton and take to nearby hospital.

Wounds :--Clean the wound with clean water and stop the bleeding by compressing,raising the wound above the level of heart or use a tourniquet to compress blood vessels. Then dress the wound with sterile cotton and bandage and consult a doctor.

Drowning in bath tub:--Take the baby immediately and keep in head low position ,press the abdomen gentely or give a mouth to mouth sucking till the air way is clear. Give mouth to mouth breathing and cardiac massage and take the victim to the hospital.

Electric shock:--Stop the source of current. Then observe the victim,if no breathing give mouth to mouth breath along with cardiac massage and take to the hospital.

28, And the last but not the least, give your child maximum care, love and support to make him healthy and happy for ever.

What we should not do?----------------------

1, Never shake the baby, it can cause damage to the brain.

2,Don't keep any small articles near the baby .

3,Sharp pointed articles like pen, pencil, ect should not be given to kids.

4,Avoid entry of water in to the ear while giving a bath.

5,Food should not be given forcibly when the baby is crying or coughing continuously.

6,Should not overfeed the baby.

7,Articles like mosquito repellents ,moth balls,ink,gum,medicines,ect should be kept away.

8,Avoid tight cloathings.

9,Should not be placed near the edge of the bed.

10,Should not give the baby to strangers and avoid close contact with others.

11,All electrical instruments should be kept away,and bed should not be arranged near electrical sockets and wires.

12,Kitchen is a dangerous place for children.Don't keep them alone in the kitchen.

13,Water level in the bath tub should be minimum and don't go for any other works(to attent phone call or calling bell ect) when the baby is in the tub.

14,Avoid smoking inside the house.

15,Should not allow pet animals to be in very close contact with the kids.(anti rabies injections should be given to pets and cut their nails properly)

16,When the child starts walking should not be kept alone on the upstairs and should not allow them to climb the steps.

17,Strong light should be avoided in the room.

18,When you are travelling don't give the food articles given by co passengers.

19,Baby should not be allowed to crawl on the soil.

20,If you are sick or someone else is sick be away from the kids.

21,Dont take the baby to hospital wards,crowded market places and polluted dusty areas.

22,Table lamp should not be kept near the kids,this will attract insects at night and cause problems.

"The C.E.O Receiving a document from the County Medical Director. This is an event that was presided over by the county administrative officers,county commissioner and other administrative leaders in the county.the event was to oversee the committee that was to oversee the process of facilitating the level 6 status."